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Home My WebLink About372 16TH ST - Building Permits� ,- . - AOP�ieanl to fill in all sDaees ekeept thofe within heavy bo�Eer Iines ana zi9� all aDo�oDriale Oaclantions. ,�.�T�� PERMIT NO. TRACT'NO. LOT NO. UNIT N Lf p'�S —I �'II — O�.vsTA M�SA CONSTRUCT(O PERMIT q,p. # '�',�FitAddress ��7 F. ICv�I-h b� 3$3 � N �� f'or S�o � �y�, S Main Building: AppliCant'SMailin Addfei5 _/lYJ1 P��'GE �Z�+o N.S� TVPEOFCONSTRUCTION"--'�uew�� .aoo ALTERATION REPAIR E +� 1 I' Ownef'S Nai'te ��%��- Phone G.��4o% � CONVERSION ❑ DEMOLISH ❑ OTHER � T Front /�� Address' 3�%2 �• �fi� ST� DESCRIPTIONOFWORK/USEOFBLOG.-�F �TJt e Rear'I� �•� (�� i ArchJEng. License No. Address Contractor's Name�_DS.L7�M� �� Phone 1 �-��$ Address Imailing) �l g �'K Ciry License No. —j. � gv LICENSED CONTRACTOR DECLARATION � I �ereby af/irm that 1 am licensetl untler Drovisions of Charter 9(commencing wi[h section 7000) ot Divislon 3 of tbe Business antl Protesslons Cotle, antl my license is in lull (orce ana effect. License CIa55 g� Lic se No. �� Date Signature WORKERS'COMPENSATION � CLA ATION I"�reby aHlrm thdt I hdve a cert' IcatO o I` COn3Ent [0 501f-in5ure of a celtificate 'orkers' Compen5alion Insu r a certlfletl copy t�ereot (Section �. �aD. C.)'�. � �." Poli<y No:, - :Company' �' "' 8 Cer[ifieG copy is hereby turnizhetl. ��. Certifietl copy Is tiletl with the tlty Builtling Division. ��.- Date - " Applicant -'� ' E%EMPTION FROM WORKERS' COMPENSATIOfJ DECLARATION (Tnis sectfon neetl nat be completetl 11 the permit is for one huntlretl ($100) or Icss). ) I certity that iR�the Performance oi tne work for whlcn this perm�[ is issuetl I sM1all not employ any person In any manner so as to becoma subject to t�e Workers' Compensation Laws of California. Oate Signature %- NOTICE: 11, atter making thls tleclaration, you shoultl become subject to the Workers' Compensation Orovision5 0l the Labor Cotle, you must torthwith Comply with such p�ovisiOnS or this p<rmit Thall be tlG¢m¢tl revoketl. CONSTRUCTION LENOING AGENCV 1 hereby aHirm lhat there is a cons[ruction lentlin9 agency tor the pertormanca o/ Ihe work fOr whlch [his permit is issuetl (Section 3097 Civ. C.) l.enaer's Name LenOer's Atltlress OWNER BUILDER DECLAiiAT10N I nereby aifirm lhat I am exampt irom the Contractor's Llcense Law for tne /ollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or county whiGh reqUi�es a p¢rmi[ [o cOnsl�uct, al[¢�, ITProve, tlemOlizh o� �e0ai� any structure, prior to its issuance, also requires the apo��ant for such permil to tile a si9ned slatement that he/she is licensetl pursuant to tne provisions of tne Contractor'S License l.aw (Chapter 9(commentlng witM1 Sectlon �000) ot D��''��on 3 ot the Business antl Protezsions Gotle) or that ne/she is ezemp[ t' �om antl the bazis for lhe allegetl exemption. Any violation ot Section i by any applicant for a pe�mll Subjects [he aOP��ant to a civil �I e.._.ry of not more than five huntlretl tlollars (5500). I, as owner of the O�oPerty or my employees with wa9es as their sole, compensation, will �o Ihe work, antl lhe sVucture is not intentletl or otferetl for sale (Section 7044, Business and Profezsional Cotle: The Contractor'S License Law tloe5 nOt apply l0 an own¢r Of a property who builtls o� improves thereon, antl who tloes sutn work bimzelt/nerself or tnrougn nis or her own em0loyee5, prOvitletl4hat Such imOrov¢ments ar¢ nOt intenEeO o� ofteretl b� sale. It, however, the bulltling or improvement is soltl within one year of com- pletioq the owner will nave the burGen o( proving he/she tlitl not builtl or Im- prove �orthe purpose oisale). ❑ I, as owner O/ the prOperty, am exClUSively tontracting with IlcenSetl mn- IfdClOI5l0 COOSIlOCI IhC PtOfCC� ($¢Ci�Ol1 %�44. BOS�f12552Od PfOiC5510l15 COdB: The ConVa<tor•5 License law tloes not applY to an owner ot property who bWltls or imoroves thereon. antl who <ontracis �or such oroiects with a con- tractor(sl hcense pursuant to ene Contractor•s Licen{e Law). 1 am aware tha[ proof of Iheir Worker'S Compensation insurance ShOultl be provitletl to me. ❑ I am eacmpt untler'Section B. & P. C, for this reason Da[e Owner I have'reatl this apo��ation antl state that the above I aaree to comolv with all citv antl roimN ortlinance5 TVPE OF PERMLT/��/ LI GRADING FO DATIO^N �L_I STRUCTURAL ❑ TENANT LQ ELECTRICAL PWMBI G LKMECHANICAL ❑�OTHER �� a b ' PROJECT DESCRIPTION 5[�. PT. � W OCCUPANCV�� CONSTRUCTIONTVPEY ��a�% VALUATIONS�.�,� ZONE GRADING CU. VDS. ACRES_ Remark5: Preventer Irrigation Drinkin9 Fountains Floor Drains Floar Sinks � Gas Servic.e 1 Outlets In[erceptore 1 Kitchen Sink 2 Lavatories P—Trap Roof Dreins Reinspection Fee � $15 Boiler Duct- UnderGround Duct - S[ructurel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO �k�p� Heating System & Duc[ing � 100,000 BTU O t 00,000 BT i��Ye�.�i�si� Mu� � . Slgnature � - Date Drivers' LI nse r SS # _� � Feinspection Fee 0865-46, r v. WM1ite - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor $15 Service Sink Sewer Cap Sewer Connection $olar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash laue Fee Hootlor Typel ❑ Canopy Typell � Refrigeration System ❑aioo,000aru ❑ioo,000 System Repair/Alteration Fire Dampers Registers Issue Fae A C Right� � g- Left � Ping. Ref. # G Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher', ,' Dryers ❑Gas ;,�Eleci Fan ` F.A.U. F.ixtures � Device Boxes ' Outlets � � Switches •. . z �p �� Garbage Disposal � ,-', Generator �0.5, I '� Reinspection Fee —Q(p � Parking ReqJProvided zo�e ELECTRICAL Trensformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps` � Sub Panel Motors � 0-7 H P � 1`h � 8 Inc.Solar �9�15 HP 016-1 Microwave � Pole Light �� Range ,� ' $i9n: � �-� �-� _�� s�� -� $ 3 DEVELOPMENTSERVICESR �,Zaning AppPoved By � FEES �Building Approvad By� �'Aooliption lauad Bv FEES $ �/� N I N G R E Q M T S. � BUIL'DING PERMIT $- -�� s,�. �SMIP $ 6• 27 � �PLANCHECK� $ 7�• e/ PERMIT PLUMBING $ �-� •a� ISSUANCE $ PLAN CHECK 25% $ — ENERGV P.C. $ ELECTRICAL� .. $ �G� •�O ' GRADING $ �PLAN CHECK 50% $ � •' MICROFILM $ 7 � � MECHANICAL s 33 • oo TOTAL FEE $ J� PLP,N CHECK 25% $ � ' '(�e / / �. �-U cool.� .. ' . ' i" . �ia.: ' ?". ., �'� .. � r ��NSTRUCTION ANp pLANNING^ POOL R SPA �. 4iPPROVALS Permit # �Date Inspector pppROVALS F �t # Date Inspector �1. Tempprary Electrical $ervice or Pole _.� � 52. Pool & Equipment Location - ti1- �2. Soil Pipe,-Undrgrnd. .. �j�sq L� 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgmd. 54. Forms - � 4. Elec�rical Conduit-Undrgrnd. 55. Electrical Bonding ," �, . 5. Steel�ReinforcemenT; �� • 56. Rough Plumbing & Pressure,Test � � 6. Electrical UFER GFnd_ �i 57. APPROVAL TO COVER-GUNITE �: ' 7. Footings '. . ' �-f7„�C1 58. Electrical Conduit-Undrgrnd. �8. Foundation '�, ' a� -� 59. Gas Pipe, � Undrgrnd., Test �• t. ��9. Water Pipe-Undrgrnd. �rF � . f�j(l 60. Backwash�Lines, P-Trap, O Undrgrnd. - �� 10. Stiuctural Floor System h 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connectjon � L� 62. Backwash & Receptor-Final 12. Sewei fap -r �' 63. Heater & Vent-Final f .. � . 13. Roof Drains ' i�, � 64. Plumbing System - Final s' 14. Rough Plumbing�� 65. Electrical-Final �-• � 15. Rough Electrical-Conduit � 66. Solar System�Final i. 16. Rough Electric Wiring � 67. Fencing &�Access Approval � � i 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING b8; Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL 19: Rough Fleating & Air Conditioning , _ FIRE DEPT. REQUIREMENT , � 20, Rough Factory Fireplace APPROVALS Permit# , �: �21,� uCtsj in Structure . �--.. � � � �� .. . ,_ _ 70. Underground Hydro � � 22. ucts, Ventilating � � 71. Product Piping � Gas ❑ Oil �'� 23.� -as Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing '.' .. '' 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing y.; 7O�p-� 74. Overhead Hydro � 26. l'-BarCeiling (Strlictural�'& Monocoat 75. Dry Chemical � 27. Fram@ and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation o8 78. FIRE PREV. FINAL . 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coal ��" 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 90 801 FOOD 6ERTIFICATE ISSUED � - 33. Final Electric � Note"s: `� " " ' � � 34. Final Heating & Air Conditioning ;, , 3� qa .�p �: � HOLD FOR SP$CIAL REQU ___ 35. Final Gas Pipe-Test Q � L�/1 �=pp $ O_"�-�GC1� C-� /�C� 36. Hood or Canopy • _ c c... ✓ �-� . a o 37. Final Fac[ory Fireplace �j ��p /�% Yy � �N 0[, p�J � UT 38. Final Plumbing /Z-��j G� Q 5 «y�. G, � 39. Water Service-Final� (6 L� L� O q O 40. Gas Service-Final � ' . n l � 41. Solar pomestic-Final" �- � � �!`� 9etl" Ca1r F-a'_ d�-�. 42. BackflowPreventer F ,.i�� ; /;� �� _i �. 43. Backflow Irrigatiori., � ) '�„ �,� � - • ' 44. Landscape Irrigatiqn System 3 a� p � �� '� 45. Sound Attenuation� i � � 46. Handicap Regulations - . . 47. FINALSTRUCTURE&BUILDING 3 Zg'p 4 ' 48. Special Requirements Completed �Zz/ � 49. Electric Release to Edison � �'� � •: �i 50. Gas Release to Southern California Gas Co � .� � • ��'� 51.CERTIFICATEOFOCCUPANCY � �� v� • `� �, ' I ,.r y ' � i , f' . No. Date ; �' � °� ^ � • �� ' = � Aoolicant lo fill in al1 spaas exceot those witnin heavy boraer Iines ana si9n a1l apv�oVriate aeclarations. CIT,Y OY COSTA MESA CONST�CTION PERMIT PE�IT NQ. O� � T{iACT NO. LOT NO. UNIT NU. Project Address s � 7 � � `— AppliCant's MailinoAdAreu ��Z •�, TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAI R �_ —_ I � OWnef'S Name �� Phone 5� Ogy63 � CONVERSION ❑ DEMOLISH ❑ OTt'HE�^/� q,p, # Zone T,�— D ¢CRIPjI OF WO K/U OF 8 q� d�`! Address �Z �� ST �� r�� ..Zi�M1—� i...�+ Q�i L� S MainBuilding: AccessoryBuilding: Arch/Eng. License No. TVP� OF PEflM1T lJ GRADING FOUNDATION STRUCTV RAL T Front << / � � /� p Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf ' �( N ContraCtor'sNam �� Z � OTHER s �S Phon C Right � ',A N Address (mailing) 2'` � � dC:—"� � 3D PROJECT DESCFIP710N 5�3. Fr. oCCUvnrvCv K Left � � � CONSTRUCTION TVPE VALUATION 5 �� $ G City License No. 20NE GRADING CU. VDS. ACRES R LICENSED CONTRACTOR DECLA . PInJ. R¢f. � Parking Req./Provided E I hereby affirm [bat I am licensetl tler prov io f Charter 9(Commencing pemarks: . Plannin9 Noter. L� � � [a � M with section ]000) of Division of t�e Bus z ntl Protessions Codo, and � my license is I full torce antl eft t. C�,yq T �icense C 52 � IC211 � S Oate �° 3 Signature PIUMBING FEES 'C�ORKERS' OMPENSATIONDECLARATION BarSink ShOw¢�5 ELECTRICAL FEES �reby attirm that 1 M1ave a certificate of Conunt to self-insure or a certificate 4`'. Workers' Comp¢nsati n sula ce, or a cerY ietl Copy thereo( (Sectlon BdCkilOw Pf¢v¢nt2� Service Sink `�3��00, Lab �� Flutomatic Washer � Transformer ❑ 15-50 KW PolicyNo.� co ny Backflowlrrigation SewerCap ConstructiomPoleSub. �SO+KW � �� rtifietl copy i hereby furnished. �E/7Certifietl opy s' wrth the cit eui�tl 9 Izi n. � Bathiubs Sewer Connection Cooking Unit Merer ❑up to 100 amps Date Applicant EXEMPTI N FR WORKERS' COMPENSATION DECLARATION Clarifiers SOIa� COIICC[O�5 DlShwdSh¢� M¢tE� ❑Ov¢� 1�OdRIpS (Thissection nee not be completetl if the permit isfor one huntlretl ($300) or � less). Dishwasher Solar Pipin9 Dryers ❑Gas ❑Electric Sub Panel I certify that in the Performance of the work tor which thii perm�t is issuetl, 1 � shall not employ any person in any manner so as to Oecome subject to the Drinking Fountains Solar Tank Fan Motors �0-1 HP �1'h- 8 Workers' Compensatlon Laws ot Califomia. � Date Si9nature Floor Drains Swimming Pool w/Spa F,A.U. Inc.Solar �9-15 HP �16�15+ ^ NOTICE: tl, af[e� making thi5 tleclaratlon, you Shoultl become Subjec[ to [he — ��Workers' Compensalion provisions of tne Labor Code, you must fortnwitn FloorSinks Urinal Fixtures Microwave comply with suth ptovlsions or Ih15 permit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV GaSService Outiets WaterCloset I hereby affirm that there is a consbuctlon lentling agency for the performance Device Boxes Pole Light of the work for which [hiz perml[ is Issuetl (Sec[ion 309� Civ. C.) Interceptors Water Heater Outlets Range Lentler'S Name Lentler•s Atlaress Kitchen Sink ' Water Service Switches Sign OWNER BUILDEH �ECLARATION I hereby attl�m tha[ 1 am examp[ i�om the Cont�acto�'S Litense Law tor ihe L2vdtO�i¢5 Au[O-W25h . followin9 reason (Sectlon ]031.5 Buslness ana Prote55ional Cotle: Any city or Garbage Disposal Standing Sections county whicn requires a permit to construcq alter, Improve, tlemolish or repair P—Trap Laundr Tra s any structure, prior to its issuance, also reqWres the aoP��ani for such permit � � Generator �0-5 KW �5�15 KW Trash Compacmr to file a slgnetl statement thal he/s�e IS licensetl pursuant [o [he prod5ion5 01 ROOf DfeinS - ihe ConVaclO/'S Liceni¢ law (Chapter 9(commenCin9 wRb Section 7000) of 'sion 3 of [he Business and Profeisions Code) or tha[ no/she is exem0� ;Gom an0 the bazis /or iha alle9etl exemption. Any violation of $ectlon ,1.5 by any applican[ for a petmit Subjec[s the appliGan[ to a Civil �enalty oi nol morc than tive huntlretl tlollars (5500). . LJ I, as owner of the property or my amployees witn wages as their sole Reinspaction Fee $15 laue Fee $ 3 compensation, will Eo the work, antl the structure is not intantlea or otferetl Reinspection Fee $15 Issue Fee § 3 for sale (Section 7044, Business antl Professional Cotla The Contractor's MECHANICAL FEES License Law tloes not apply to an owner ot a property who builtls or imp�oves DEVE�OPMENT SER VICES REQUIFjEMEN S3 tbereon, antl who tloes such wOrk nimseu/nerseit or through his or her own BOiI¢/ HOOd 0� T 21 ❑ p emplo ces, provitlea Ihat SUGh Improv¢mentt are no[ Intentletl or offeretl for VP - / � � 0— sale. It, howeve�, the bulltling or improvemen[ I5 soltl within one yea� oi cOm- ZOning App�OVed By Y Canopy Type I I ❑ ��k w0 Date ple[ion, [he owner will have the bu�tlen o( proving he/s�e tlitl nol builtl ot Im- DUct � Und¢! C�irouOd BUilding ApprOv2d By DetB �/Ove for the purpo5e of sale). � I, as owner oi the property, am exclusivety contraciing with licansea ron- Duct -Strucmral Refrigeretion System Application Issued By Dat tractOrs lo construct the project (Section 7044, Bu5ine55 antl Prof¢sslons CoOe: Tne Contrac[or's License Law does not appty to an owner of property who Duct - Ventilating ❑0�100,000 BTU ❑100,000 BTU SUMM�RV�pF FEES builtls or improves lhe�eon, antl who cont�acts tor Suth projecl5 wlih a con- tractor(sl iicense pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ '�'� Bp SMIP $ QrsO proo/ o( tnev Worker's Compensation insurance snoula Ce provitleG to me. PLAN CHECK $ 27 /� PERMIT - ❑ I am exempt untler Secti e. 8 P. C. for this reason Firepl/FacL BIC ICBO # Fire Dampers PLUMBING $ �SSUANCE $ oate o r Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. S i he oy certity t I hav r ad is a piication antl state thae tne ab ve ❑0-100,OOOBTU �t00,0006T ELECTRICAL $ GRADING S int mation is cor .t. I a9� ty vith all city antl county ortlina es an siate laws re in9 to uil'i tr ction,antl hereby authori r re- . PLAN CHECK 50% $ MICROFILM 5 sen atives Of th' i[y e � P�� E0I10024 pro rt jp� 1. ins ection purpo P �•'1 � Sign re Date �:7 3�� MECHANICAL $ TOTAL FEE , S '�� Drivers' Licens or 55 � � Reinspectian Fee S15 Issue Fea $ 3 PLAN CHECK 25% $ __ _ _ _ . CMF 0865-46, rev. 30/84 White - Builtling: Canary - Applicanh Pink - Atcounting; GoltlenrOtl - AsSessor � � - � �' �� - �i� C• . '' CONSTHUCTIQN ANDPLANNING POOL&SPA � APPROVALS '� Permit # � Date Inspector AppROVALS Permit # Date Ins{iector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , � 58. Electrical Conduit-Undrgrnd. 8. Foundation� ,- . 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains 64. Plumbing System � Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-Conduit . 66. Solar System-Final i 6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace . APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Strucwral) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT % 31. Plaster Brown Coat 79. FINAL INSPECTION �. �� 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED �� 33. Final Electric Notes: r /o-,.. 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace „ � • 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final - 41. Solar pomestic-Final 42. Backflow Preventer - � 43. Backflow Irrigation . � � 44. Landscape Irrigation SYstem � , • 45. Sound Attenuation � 46. Handicap Regulations � , 47. FINAL STRUCTURE & BUILD WG � �� - � . . 48. Special Requirements Completed . - . 49� Electric Release to Edison � ' - 50. Gas Release to Southem Califomia Gas Co '�� 5L�CERTIFICATE OF OCCUPANCY • r ,. No. Date ` . �� /V�i,�� '� 1 2HZS AQ2EEt�l'i`, made arc3 entered intn this � day of ' OC-T` , 198�, by and between ' O� �-�=�-1 i 1 hereinafter referred tr� as "LAND G4d�7ER", and �� t— L,C� hereinafter referred to as "P.DJACEN'P PROPER'CY CWNE�2". Zt is hereby agreed that a praperty line beri,�een rrall wi11 be constructed on the j-7 � l;�Co �� i . �f ABjoining Prc�perties) in the City of Costa Mesa, Co�mty of Orange, State of California, as per map reconled in Book , Page_ of Miscellaneous Maps, in the office of the Coimty Ra��de�' of said Coimty. The party wall shall be permitted tn encrxd� � 0 � \ IN WI'INESS 4diEREOF, the parties ha�e entered into this Agreer�nt the day arc3 year fiist above written. .'\ ' , � LAND Q�NER � 7a. �: ,�� T (Adciress), 1 A0.TACF.NT PROPER�1' (k;NER I�R� � Q tt�f�� df�% (�Yved or, Printed) � � � � � l � �'� S,L (Address) (p�(p'F� Pl�+acn c.a ravar�� airla �r nn�t) ,,, ��;� F-� � � 1 lti � City af C'^ ^ Mcsa Building /Dept. BY � � DATc �D/� 19_�'_/ ThE.`.E Pl.ANS MUST 9E ON 1C� AT All � I�b1E5 MAKE NOCriANGFS WITHG::T Pi2�;OR c,ppROVAI OF DEPT. TH��ISSUACtC` CR G�AN?ING C` F:-°` ? OR F.PFROVpI OF FLANS Ar:D ofECiFlC 4'.ICY�� i SHA[L k:,�? BE CONSIRL'ED TO BE A PE,Rh11T FGR. `•�3 AN nPi'FOW t. GE APPf `✓IOInilON OF pt:Y OF 7H� ��'��' ��V'�= C!' 1 N�`� IODC. I'�J 7EkPn!1 Ff:SUMiNG f0 GNE AUTNOHIT: ?:: ':10.. ii' Ck C-hCCL'iF;E "ROVISIONS OF iH15 CO!�F. SNAL 62 \'C,? ��, iXCE°� 'r' S0 Fk"✓. !.5 ?HE WORK Ct USE KHICH 4 P'JikiOP.iZrS LS :AWFU!. y THE IiSUANCE OF A FifCdiT BAS:D UPC� PLTNS �iND p f .y^..^.�S SNqll NCT PR"cVEUT i'iE BUIlO�nG OtFICiaL .. ., ��:Ed�9:�' iF:: !:iGU15�VG THf C08RECilON GF ERRORS IN . . • . '^�C':r�••;•,> "•R CROM PREVENiING � 'n+P.' - CEI::C ^"'�c�::•1 ""REUNDER WHEN :. !:JE C;, G- ph• OiHCH OR��NRUCE OF � B[t10[NCE � W Q N ..� L, L �' Sr� �C `� �� l `��'R�VED � � NNI� �� /Y�( ( �i...��_ °�' m0. �� ^ r��l �� N �"� � �'� P,*,c'' � II[!ID[MC[ 11[SIDENtt "�i'7 L� � `�J%(o � -kS�i � 3°� �'w w•- �� pEET � INSPECT90�S RE81D[NC[ TYPICAL 6�� CONCRE�TE BLOCK FENCE Cement Coping OPtional —^ Channel Bbck With 13/8� Horizontal Top of all Fences For Fences 5' or Less Vert. Bars 3/8" � at 4' -0" O.C. Por Fences Higher Than 5' Ven. Bars 3/8"¢ et 32" O.C. � Fill Celb Solid With Grout Where Steel Oceurs Reinforeing Steel Shall Conform to Sec.A-15-39 A,S.T,M. Ail Steel to be LapP� 24" or to Code NATURALGRADE TW0�3/6••� BARS �—I CONTINUOUSTOP. � & 80T70M }10R1=.STEEI MUST gE TIED IN PLACE AT TIME OF TRENCH INSPECTION. ua �D F�-- W IDTH p' SEE CH6 v BE�OW D' L , >� . FOOTING REQUIREMENTS �CHART � �ENERAL- NOTES MORTAR: p�e Part Plasfic Cflment, and Three Pa►is Sond GROUT; p�e Port Cement TNee and One Half Parts S�and COPING: pne Pert Cement, Three Ports Sand C�NCRETE: Well Mixed 1:2-I/2:3-I/2 Max. of 7- I/2 Gollons of Wafar Per Satk of Cement GROUT MHY BE POUHED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLS ANO AREAS OF MORIZONTAL REIN� f-0RCEMENT SHALL BE CLEAR, CLEAN & FREE OF ALL NIONTAR DEBRIS, ETC. H OF EARTICTCOTH I/3 THE HEIGTH OF FENCE �ELOW �BOTTOM OF FOOTING. SCALE: I/2" = I' , ... --- -- - - - • ., . . � I2°. S WIDTH . . . . . . . . . . . . . . .14" . '. . . . . . . .' . . 14�: . . . . . . . . . . i._12":,-:... _ -_ . . THICKNESS . . . . . . . . . . . .10��. . . . . . . . . . . .10�� . . . . . ' . .'. . . 8u. . . . . . .'. . . . 8�� DEPTH OF EARTHTOOTH . . . 24" . . . . 20'� . . . 16". . . . . . . _ . . : 12° SPACING OF EARTHTOOTH. . 12' , 14� . . . . . . . . . . . 16'. . . 16� r OWNERS N : A _ . C��y OI �OJIQ Mesa, California pORMAT�DNUMBER _ � � S r� __ Building Department SIGNATU — _ — _ _ _ _ _ ��::.. r.:,_�.�_._,.: rz.EvrSEp r,iov.ez CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant: �a33�' , � J A d d r e s s: �,'� ;� ��G-1 ��Lc.`Y� N��Po¢.� �Gr,4. C� �QoP� Telephone Number: �-}�4� �14g'- 1`�'�t�--� Tract/Parcel and Lot Number(s): Location of Project: 2��►Z �• ��Co�' c'ST• l_�os7a �. �•�17(�,�i-� Number of Square Feet of S'/aF? _ 02 3 90 ,� �O -7 0 0 Residential Space �� 3 p x$1.50 Total Number of Square Feet of Commercial and Industrial Space Commercial/Industrial Project is: Mini-storage Movie Theater Racquet/Health Warehouses Heavy Industrial Regional Shops Light Industrial x $0.25 (Check One) Total Motel Bank Neighborhood Shops R & D Hotel Medical Office Office Park Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food / The provisions of Government Code Section 53080 are not applicable. This certifies that the above-named Developer/Applicant has paid school. facility fees in compliance with Government Code Sections 53080 and 65995. Checks are to be made payable to Newp t-Mesa Unifi� 1 District. �� . t.�/ /C. Busi�ss Manager Newport-Mesa Unified School District The above representation as to square footage is true. Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: 4• �' � �- I�a.�o u �� Q�,-C-�-� ; elo er/Appr'icant MAY '� 1 t9S9 � � -� -- - _ bar� : �/,a.� `l . � ��l c� t -- .. �'o.:. G.� oF C�-�-r- *�1esa . --- - -- - -_ R�� _C��p,�c� . v.err-��.�� - ��-c-�� : �� z �. t�-� �—, . C'-�r�a r�c-� � - �z.�z� _ ._ ; '�'1t� _ 5bt o _Pe.��a� � _ �-? s��z-�,a,� � - ------ -- -•' ' W �T�-�---�� PR�'a _U-�`t __�¢-m�, �b Pti-rrr-�. '-fi� - - -- -- - ..L� . �� -- 'S`-1FF`c�cr.7t PP_�rJr�c�E. � -P�'�- � -- _ _ _.:.��-A".� .`�(�-iG ��All�i __�_'F E�o"flh _ dU�t-�bIrJC�.S _ � c�,.i p t�-+�'�5�e e.n �R-�5 a� 4r� P�,,J � ------ --- - �_. ��o -- .�sa.-�- --Ap�a v.a�.c _� w� sv�. t ;' - - - - -- - - - - ------ - - - i - - ��.�P�uc.�.Y �cil��, , � - - ------- ----- -- - -- ---- - - - - - --- - - - oc� �_ �..-� Gaty-t �r.y�, - - -- . L lL � 5� �S"] - - - - - - i: - - • ------ --' ---- -- - - ---- - - — - -- - --- � ---- - . i p� y � ': � b' G�,�C o P Cv�,� w�l.� �. . { i _ - - — - — - — - - �"1Z � . l c�`�'— �G : T1-4� ��c�—, Lo c,r�� '� �.-i ! . ��c�`�cn _v-�`G��G� . `1 Zto7�� l� �.J A��o�t� A-tisc� - - - - - -�/-t l� . �k�T: �pR�a� � Fac�,� _ EZ-rZC1�..L � �t3r�..k3r�� i��-� . rI _.Sp�� 'oX?L�i' -�Zo�- �al r-�PL�� S " . . ��PS �� t�J Tb G-d-'�Pt�C—i�. . �(Zo.�t?L-T p�S� ri �r�ec�'( `ro� . oc�uP.�c�`-S . � - - . � o „�0�,..0. �- �,., .� �.,.� � , _ �� Po� - -- - ! - -- - - - - --- - - - - - — � - - — _ �Y�� '� 19 9 c7 �� - - - -- — _p�. . .. . _ _ 3 _� _ I _ ' _________ _-._ _ __ _ _ __ __ _ ___ ___ . _.___ _ _ . _ . " -_ ..__'_.-_ . .__ _ - __" ! - -_ __- --_ _ . _ _- _ _ _ _ " _ . . _ -. -_-_`__. _ _ _ _ _ _ ' ". . -__ - _ _ _' . _ ____-_ _ _ __. _ ____-_._--_.__..__�_�"___._ " .- '_ " ; _ _ _� _"_'-' . - ___- _-_ _- _�_..___ -____ __ _ ' _....___.. __-_ . - ' __.__ _. __- `__'_�:_' __'_____.____._"__-.-___ _ _._ _ . . . _'. _. _ I _._ _ ___ _ . -3- � . .. _ _ .. _ .. _ , _ � _ . . _ . . . _., . . .� � . �. . . � " _ _'. ' .t 1__.-_ _ _ _ _ _ _'_ ' ' _ '_ "'�" _'—'__- . ' ' ' _ _ __ __ ._ - __ 1� -_ _' "_'_ __ _ ' _ __ _ —__ __._ _ ' . _. _ _ _ _ '_ . . � � - ------- -- -".--- - -' - - - - -- --------- -� ----- � � - - � � --- - - - - ;; . -- ----- �. ._-� -"--�------.--' -- �- - ' I� j _ - ►..TY OF COSTA CALIFORNIA 92628-1200 Insulation Certificate MES ? P. o. eox �mo 3'12 �E, �%`�` �SC' Gc�srr� v--t �,�- w,�,� �a sar« c�ty ��'� . ca�„ty ROOF Material 'Ihiclrness (inches) EXTERIOR WALL s�ta;ri�;�, t.�� N��r Description of Installation Brand Name 'Ihermal Resistance (R-Value) Material '�1�t.%Q-!o: "= BrandNarne 'Ihiclrness (inches) �" '3 � 1 T � 'Ihertnal Resistance (R-Value) fL — � l CEII.ING Batt or Blanket Type � J (3t,0.,`��c.[�c Brend Name �.J L�. �-5 �� fLu � ��_ 'Ihiclrness (inches) �� " 'Ihertnal Resistance (R-Vatue) LZ —1'� Loose Fill Type vJ O Brand Narne Convactor's minimum instailed weight/ft� Minimum thiclrness inches Manufac[urer's ins�atied weight per square Coot to acheive'Il�amal Resistance (R-Va(ue) RAISED FLOOR n Materiai S�S '`�Tp-�.t�c sz P�-Y 'Ihic}�ess(inches) ___ _ SLAB FLOOR Material 'Ihiclrness (inches) /Z" Width (inches) Brand Narne 'Il�ermal Resistance (R-Value) Brand Name 'Ihem�al Resisrance (R-Value) FOUNDA7'ION WALL Material �i�tx.Q-�C� Brand Name 'IhicFa�ess (inches) Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Budding Energy Efficiency Standards for new residential buildings contained in TiUe 24 of the Califomia Administrative Code. � Su6Convactor(Insulazion Installer) Signanus nnd Title �r I SL'Ca $5 "�I License Number —� l-, I �.b Da�c Licrnse Number ADP��ant to fill In all spaces except tnose within heavy oorEer lines antl sign all aooropriata aeclarations. CITY OF COSTA MESA CONSTF�ICTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. P�y Project Address �y �� T' _ Applicant's Mailing' ALddress �"'�+� 4«�"� � Z�_� Owner'sName �a�`''�N Phone Address S�'�� Arch/Eng. Licenu No. Address /'�.�, Contractor's Nam � �-1 'Q""�� --^� � Phone 1�-1� Addresslmailing) �g7s 1 «'µ#Z�� N'g' Ciry License No. U 1�OR LICENSED CONTRACTOR DECLARATION I hereDy aHirm tha[ I am Iicensed untle� provisions of Chart« 9(commencing witn seclion 7000) of Division 3 oi the Business antl Profe55ions Cotle, antl my license is in full force and eHect. �6 �i^ License CI ss � L fr�e N. P� � Date�� — Si9nalure ppp WORKERS' COMPENSATION DE�TION I Itereby a/firm that I have a certifl te o( COnient to selt-Insure � a certiflCate Workers' Compensation Insura ce, o a certifietl CopY �h reof (Section lab. C.) y No. Company Certifietl copy is hereby fumizhetl. Certltictl copy is filetl witb the dry Builtling Division. Date ApPlicant EXEMPTION FROM WORKERS' COMVENSATION DECLARATION (Thissection naetl not be mmpletotl if [he permit is for one huntlretl (5300) or less). I cerlify that In the perfOrmance ot th�k t0/ whicjf(hls pe�mit is i55uetl, 1 snall mt emolov anv oerson in anv m e� so as y6 ppcort� subject to the Workerj' tion l.aws of CaIlfqln� �v.// Dale � Si9na[ure � •�l�L rvoTl[ : if. a ter akino tnis tleclar tion. Y u shoultl becoma CONSTRUCTION LENDING AGEriGV� / 1 here�y afflrm that there is a mn5tru<fion lentling agency for the performance of [he work for whicn tbis permi[ is issuetl (Section 3097 Civ. CJ l.entler'S Name Lentler's Atltlress OWNER BUILDER DECLARATION I hereby atfirm lhat I am exempt trom the Contractor's Licenze Lnw for the toliowin9 reason (Section ]031.5 Business antl Protessional Cotle: Any city or county wnicb requires a permit ro ton5[ruct, alter, ImOrove, tlemolish or repair any s[ructure, prlor to ils issuance, also requires lhe apPlicant for such permit lo tile a sign¢tl italement [�at h¢/She Is lit¢nSCtl pu�suant IO tne p�ovisions o( the Coniractor'S LiG¢nse Law (Chapter 9(Commencing with Section ]000) of Division 3 ot lne Business antl Protessions Cotle) or that he/she is exempt �herefrom an0 [he basis lor Ihe allegetl exemptlon. Any violation of Section 31.5 by any apP��ant for a �ermit suDjects [he applicant to a civil ialty ot not more lhan tiva huntlretl tlollars (5500). '� � 1, as owne� of thC Property o� my em0�oyee5 wllh wage5 ds their Sole �I Compen5a[iOn, will tl0 lhe wOrk, antl Ihe structure I5 not intentletl o� otf¢re0 /or wle (Seclion 7044, Business anG Professional Cotle: The Contractor's License Law Ooes not appy to an owner of a property who builtls or improves tnereon, antl wno tloes such work himself/hersolf or throu9h his or her own employoes, provitletl that such� improvemcnts arc not intentletl or o(feretl !or sale. If, howeveq the builAin9 or improvement is soltl within one year ot com- pletioq the owner wlll have the buraen of proving he/she tlitl not builtl or im- prove forthe purpose of sale). ❑ 1, as owner O/ [he OrOperty, am ezUusively ContraCting with Iicensetl Con- Vactors to construct the project (Section 7044, Business ana Professions Cotle: Tne Contractor's License Law does not apply ro an owner ot property who builtls ov imoroves thereon. antl wno cont�act5 �or Suth oroiecl5 with a r.on- tractor(s) Lcense pursuan[ to ene ConVactor•s Litense Law). I am aware Ihat proof o1 their Worker's Compensation insurance snoula be provitletl to me. ❑ I am exempt unGer Sectlon 8. & P. C. for [his reason Date Owner I hereby certlfy Ihat I hav¢ rea information is correcL 1 agree to antl state lawz �elating t bulltlir sentatives f tKs Cit en r Inspection p es. Signature this applicatlon antl state that the above omply with all tlty antl county ortlinantes consl�uclion, antl he�¢by authO�iie �ep�e- upan th¢ dbOve-mentiOnetl p�operty for 1 naraS�ll �l3� � 3 s3 S�—k Z ". . S Main Buildi TYPE Of CONSTRUCTION NE:V AOD ALTERATION REPAIR E . ❑ CONVERSION ❑ DEMOLISH OTHER T Front DESCRIPTION OF WORK/USE OF BLDG. I A Rear ' C Right TVPEOFPERMIT GRAOING FOUNDATION STRUCTVRAL K ❑� ENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAI S L2ft YJ �oTHER TIT�^P �Al2�' Po(r� ' Ping. Fief. # PROJECT DESCRIPTION 5Q. FT, oCCUaANCV Planning Notes: CONSTRUCTION TVPE VALUATION $ 20NE GRAOIfVGCU.YDS. ACRES Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fae � $15 Boiler Duch Under Ground Duct - S[ructural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO �k Heating System & Ducting ❑ai oo,000 sTu O i oo.000 Reinspection Fea DrWers' cen or 55 � ' � � 0865-46, r v. 5/ - Applicant; Pink - Accountin9: Goltlenrotl - Assessor $15 Showers Service Sink Sewer Cap Sewer Connection $O�df COIIECLOfS Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heacer Water Service Auto-Wash I�sue Fae Hootl or Type I ❑ Canopy Type 11 ❑ Refrigeratlon System ❑0-100,OOOBTU ❑100,OOOBTU System Repair/Alceration Fire Dampers Registers laue Fea � Zo�e Accessory euilding: Z O N I N G R Parking Req./Provided E � M T S. ELECTRICAL Automa[ic Washer Transformer ❑ 15�50 KW Construct ion Pole Sub. � 50 + K W Cooking Unit Dishwasher Dryers OGas ❑Eleciric Fan F.A.U. Fixtures DCVIC2 BOXES Outlets Switches Garbage Disposal Generator �0.5 KW �5-15 KW Meter LJup to 100 amps Meter ❑over100amps Sub Panel Motors OP7 HP �1h-8 Inc.Solar 09-15 HP �i6-15+ Microwave Pole Light Range Si9n Standing Sections Trash Compactor Fee I$15 � � luue Fea FEES $ 3 DEVELOPMENTSERVICESRE�UIREMENTS: Zonin9 APProved BY �ate FEES Building Approved By _Date-(�-�--�� Appliwtion Issued By � Date �—1 1"-C.� \ SUMMARV OF fEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE $ PLAN CHECK 25% $_�� ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLANCHECK 50°6 $ MICROFILM $ _� MECHANICAL $ TOTAL FEE $ ZL — PLAN CHECK 25% $ $ 3 •'�7� :'u=-Cu03s2��; l''�+7 :. . . :�":. L� :7/&9 ?ifi6= :::,, CONSTRUCTION AND PLANNING POOL �A APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector i. Temporary Electrical Service or Pole ��5� 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -p� �; 53. Steel Reinforcement i 3� Electrical Conduit Utility-Undrgrnd. 54. Forms � 4; Electrical Conduit-Undrgrnd. 55. Electrical Bonding � . � �5: S/eel Reinforcement 56. Rough Plumbing & Pressure Test �' � 6. ElectricalUFERGrnd` - -57. APPROVALTOCOVER-GUNITE , 7. �Footings � �� ' ' 58. Electrical Conduit-Undrgmd. 8. Founda[ion :; � 59. Gas Pipe, O Undrgmd., Test 9: Water Pipe-Undrgrrid. � �� 60. Backwash Lines, P-Trap, O Undrgrnd. _ 1�0. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection �' 62. Backwash & Receptor-Final 12. �Sewer Cap '^ `', "! 63. Heater & Vent-Final � : 73. Roof Drains �" � 64. Plumbing System - Final . 14. Rough Plumbing 65. Electrical-Final . .- 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-RougFi & Test 72. Underground Flush 24., Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25.}Roof Sheathing 74. Overhead Hydro 26. =T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ' ,76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric %�`� �� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � -. 41. Solar pomestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation ' 44. Landscape Irrigation System � 45.'Sound Attenuation 46.� Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY - , No. Date � � ApO��ant to flll In all spaces eMceOt �hose within heavy GorOer Iines anG sign all appro0rlate Ceelantions. GITY OF COSTa MESn' CONSTRUCTION PERMIT Proie�l�Address 3� z� �/6� �•`t1��4-h �" . Appliwnt'slJlailin Address ;t��gg��N�Z«� —� �• ��y� Jwner'sName ��Q� Phone�fG7!_LrFj Address � �'� F �� • Arch/Eng. ^ License No. Address �,�� ,� Contractor's Nam one J-'I.1�GC� Address Imailingl �,�Q'�� p�1y��O� '�Z� �g' CA �� City License No. ��,p✓ D LICENSED CONTRACTOR DECLARATION I hereby ai�i�m lhd� I am Ilcensetl untle� prOvisions of Chd/te� 9(COmm¢nCing with 5¢CtiOn 7000) Ot DlvislOn 3 Ot Ih¢ Busine55 dn0 Pfof¢SSions Cotle, antl my license i5 in lull lor<e dntl eif¢Ct. License �a55 � Lice e lo. Date Signature 'WORKERS'COMPENSATION DEC AR TION I hereby a/iirm that I hdvG a cerlitica e o1 ons�nt to selttinSur¢ Or a C¢rtlfitdte f�orkers' Compensation Insuran e, or a c¢rtifiea copY tnareof (Section 800, Lnb. C.�,.. � . � �Policy No. ' � � , Company ' • j 8 Certifietl copYas hereby turnishetl'. , � Certitietl copy,is iiletl with the city_Bu(Itlin9 Division. � oate ' � - � Aoa��carit ", �" EXEMPTION FROM WORKERS' COMPENSATION OECLARATION � (This seclion neetl not De completetl If the permit is for one hunaree (5100) or . lessl. �' - . � ' � ' I certily that in.lhe pertormance ot lhe wo�k fOr whiCh thi5 ptfm�t Is izsue� 1 snall not employ'any'parson in any manner.zo as to becorime subject to t�e' Worker5' COmpGnsatiOn laws ot CdlifOrNa. - � Date - S�9�ature = �" � NOTICE: It, atter making this tlatlaralion, you shoultl become sub7ect to the� Workers' Compensation provisions ot Ihe Labor Cotle, you must forthwith comply wlth sucn O�ovl5lon5 Or [nis p¢�mil shall be tleem¢tl revokBtl. CONSTRUCTION LENDING AGENCV I hereby a/lirm that there Is a constructlon lentlin9 a9ency for tha performance of Ih0 work for wbich lhiT 0<rmil I5 issuetl (Settion 3097 Civ. C.) LenOer's Name Lender's Atltlress OWNER BUILDER DECIARATION I hereby allirm lhat 1 am ozampt Irom the Contractor's Litense Ldw tor [�e lollowing reason (Sectlon 7031.5 Business anG Protessional Cotle: Any city or counly whlch requiras a pe�mil IO cOnsVUG[, alte�, Improvl, Oemoli5h O/ �epair any structure, prlor to Its issuance, also requlres the applicant lor zucn permit lo Ii10 a 5ignetl Statement lhdt he/ih¢ Is Ilcensetl pUrsUant t0 th¢ ProvlilonT 01 roe Contra<tor's Licensc l.aw (Chapter 9(commencing with Sectlon 7000) oi ni�ision 3 of thc.Business antl Protessians Cotle) or that he/sne Is exempt .elrom anC the basis tor tne alleged exemptlon. Any viotation o( Se<tlon d.5 by any aOClicanl for d Pe�mil SUGjects the applicant f0 a clvil .ialty of not more than iive nunOretl tlollars (5500). � b I, as ownc� of thu Oroperty o� my ¢rtiPloyee5 with wage5 d5 their Solo compensation, will tlo lhe work, antl lhe ztructure I5 not Intentletl or offeretl lor sale (Seclion 7044, Business antl Profe551onal Cotle: The Contractor's LI<ense Law tloes nol apply co an owner ot a property wl�o bulltls or Improves lhereOn, antl who tlOCs suCh wOrk hlm5¢II/hers¢II or Inrough hI5 ot ner own emplOyees, provitlCtl that SUGh ImprovOmentS are not Intentletl o� o(teretl lor sale. II, howevOr, tbe bull0ing or ImproveTGnt is Soltl wlthin one yBdr ot com- plclion, thu awnor will have tho buraen of proving he/she tlitl not bulltl or Im- prove tOr lhe purp050 OI sa10). ❑ I, as owne� o( lhe property, am excluslvely Cont�actin9 '�'��h Iicensna con- tractore lo wns[rUct thC pro�ect (Sectlon 7044, Business antl Professlons Cotle: The Contractor's Li<unse Law does no[ appry to an owner ot property who builtls or Improves tnereon. antl who contracts for such oroiects witn a[nn- tractor(s) Lcanse pursuam [o [ne ConVactor's License l.aw). I am aware tnat ' proof o( titeir WOrk¢r's CompanSaliOn MSurance shoultl be provitle� to m¢. ❑ I am exempt untlar SecHon B. S P. C. for tnis reason Oate Owner I hereby <ertlty tnat I have rea0 tnls aoP��wtion antl state ihat the abova Information is correct. I agree to <omO�Y �+'ith all city antl county oralnances antl State I wz �elating t0 Iltling conitructlan, dntl hereby authOtiEa r¢D/e- sentatives o is cily t �ter pon tne aoove-mentioneC property for inspection pur e . Signature Date 5�� D' e L'c 55 $ �'� � I I Reinspection Fae � S75 0865-46, rev. 5/88 WM1ite - Bulltling; Canary - AOPlicant; Pink - ACCounting; Goltlen�Otl - A55855or G- 3� 3-s'� I�N�.u,o.-F +�t.$ �or5(o � i3 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. 'e ��X TVPE OF PERMIT GRADING�--N�J/ FOUNDATIO�N �?_1 STRVCTURAL ❑ TENANT ELECTRICAL LJ"PLUMBING LSMECHANICAL ❑ OTHER PROJECT DESCR�P71oN so Fr OCCUPA^N'Cv ' M•� CONSTRUCTION TVPE V� ti% CRLTl37VALUATION S y%��F •�L ZONE GRADINGCU.VDS. ACRES �Ramarks: � ++G Sink Preventer Irri9ation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Se.�ice 4 ouuecs {itchen Sink Lavatories P—Trap Rooi Drains Reinspaction Fae $15 Boiler Duct- Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact.6lt. iC80 #�yi Heating System & Ducting �90�100,000 BTU 0100,000 Showers Service Sink . Sewer (:ap Sewer ConnecJion • Solar Collecmrs Solar Piping i Solar Tank Switnming Pool w/Spa Urinal Water Cioset � Water Heater ;,�. - Water Servic9-'� Auto-Wash FEES A.P. �Y+ a. _ S Main Building: TFront (' � ARear 1� � C Right ' g Left Ping. Ref. # a� Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher : - , . - Device Boxes '� OU[I2L5 , � SWitChES .. b Garbage Disposal .> _„ Generator O0.5 KW laue Fee E 3 iANICAI FEE Hood or Typel ❑ Canopy Type II ❑ Refrigeration System ❑aioo,000sru ❑ioo,000eru System Repair/Alteretion Fire Dampers � g Registers ' � Issue Fee � Fea �9-3►� — � Zone � �.. Accessory Building: b�_ O N I N G R —Q�p Parking Req./Provided � E )R SP CI tcu M T S. ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW y Meter ($up ro 100amps Me[er ❑over 100 amps � . Sub Panel ' . Motors �0.1 HP �.1'6 - 8' Inc.Solar �9-75 HP �16-75* Microwave � � Pole Light . Standing Sections 15 KW Trash Compactor �DEVELOPMENTSERVICESREUUIR 'Zaning'APProved By �• �� 'Building Approved By _ �'j '"""�T luue Fee FEES � SUMMATiV OF FEES BUI�DING PERMIT $/f, G� 2_.sb SMIP $ l9• 5�S PLAN CHECK . $ �T'?_�L, PERMIT PLUMBING � � $ �.Z•�a ISSUANCE $ PLAN CHECK 25% $ ENERG� P.C. $ E�ECTRICAL '.� $ � GRADING S PIAN CHECK 50% $ �'�— MICROFILM S MECHANICAL — $ �� TOTAL FEE $ � PLANCHECK 25% $' 'Z/ �' • - _ . ' .. - ,r-_ ` .' � � CON$YRUCTION AND PLANNING � , POO! �PA �. �(aMPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Poie 52. Pool & Equipment Location � 2. .Soil Pipe=Undrgrnd. `•., �y(�c+ `�� 53. Steel Reinforcement -�� 3. -Electrical Conduit U,tility-Undrgrnd. 54. Forms , 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding _ 5. Steel;Reinforcement.�j � 56. Rough Plumbing & Pressure Test _ 6� ElectriCal UFER Grnd. � P • 57. APPROVAL TO COVER-GUNITE � � i , 7. Footings � ,` ; ��'' , . � / 58. Electrical Conduit-Undrgrnd. 8. Foundation �'�, � � 59. Gas Pipe, O Undrgrnd., Test �� I 9. Water.Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. St�uctural Floor System ,� 61. APPROVAL TO DECK 11. Property Sewer Line•& House Con;ection s2/� L� 62. Backwash & ReceptorFinal 12. SAwer Cap '�: � ) . 63. Heater & Vent-Final �, 13. Roof Drains ' �• 64. Plumbing System - Final i . , 14. Rough Plumbing� � ' �i� 65. Electrical-Final ��' 15. Rough Electrical.Conduit � ' 66. Solar System-Final �16. Rough Electric Wiring 67. Fencing & Access Approval � i 17! Rough Wiring Sign 68. APPROVED FOR PLASTERING �78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT J } I 20. Rough Factory Fireplace APPROVALS Permit # �. Ducts, in Structure 70. Underground Hydro �- t . 22. Ducts, Ventilating ', 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe�Rough &Test �� 72. Underground Flush � - 24. Roof Framing �i , 73. Undergrnd.StorageTank �Gas ❑Oil �5. Roof Sheathing �,� - 74. Overhead Hydro ' 26. T-Bar�Ceiling (Structural) & Monocoat 75. Dry Chemical ..: 27. Frame and Flashing � j�' 76. Dry Standpipe � 28. lathing &'Siding t� � 77. FIXED SYSTEM FINAL 29. Insulation Q y g� 78. FIRE PREV. FINAL 30. Drywall�Nailing q fc � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coa�t • 79. FINAL INSPECTION 32. Elect�ical Power Meter-Final Z � 80. �OOD;CERTIFICATE ISSUED ' �� i, � r, , • 33. Final Electric ' Ndtes: „ � - 34. Final Heating & Air Conditioning T� (�i� ,(�� . ;�, HOLD FOR SP$CIAL •,� 35. Final Gas Pipe-Test- ' �6 ��q••Lep Z�i�t� � 2K� � 36. Hood or Canopy � cc 37. Final Factory Fireplace• �j $' �IO L� �_ G S 38. Final Plumbing - 12-d-�Q GfsIJ 7 39. Water Service-Final. _ 0'ei L� O tSf )� P� /tt/J 40. Gas Service-Final • - - GX c- / �v orv o 41. Solar pomestic-Final � � _ y 42. Backflow Preven[er- ' 0j6 � �� 43. Backflow Irrigation � ' . . " ' , �44. Landscape Irripa[ion-System � �' � �' � 45. Sound Attenuation , � � 46. Handicap Regulations � ^ . '� 47. FINAL STRUCTURE & BUILDING 3 L3 �0 � 46. Special Requirements Completed /u/ 49. Electric Release to Edison ;� .� , � � 50. Gas Release to Southern California Gas Co . ' 51. CERTIFICATEOFOCCUPANCY ' � .,J 'J1 . r No. Date � � - � � � � ' � ,�� - � �i . - - - - - - - ---- - -i -------- - - -- ---._,--. -- -��...-- --- 1 ------ ------ -- - -- - - ----- -'-- - - ; y- - - - - - - --- - - - --- ---- - ---- - - --- ---- - ' - - - - -- - -- -- - --- ----- - ----------- � - - - -------- -- -- , �- - -- i� ------- - -- -- ---------- - ---- -------------:_�---- �� - ------ - - .-- -� ------ - - --- ----- -- -- 'I -- - ------ - - - --- -- - -- . - - - -- -- -- `� - ------- - ,� -- -- - - ;� - •�- 5e�s ,� �I `l -- - - - -- - - - , — _.. . --- - - - - -- - -- - - - — --- --- -- -- - r��{ - � �,�Y Q �0 - -' - - - ' ' - - ' `. - --- -- --'-- Y-�«J 1 _-___ --..._. .. . _...'--_ - __—_-'--.__� _ -__ _.I.i_ � __ _ ' ___"__- ' ._. . .. _' __' ' '__. . ___- -'__ '--'__'___"'._"'_'_'.—__' _ ._'". _.. _ f'_'_�_-__'__ . _ � �s'�" L'� %1-Y7 .y.,-.� v� _ � _ . _ ' " ----- -- � -----..�'.--------- - - -- �-�- - - - -- - - - ... . -- -- 1 -- -----' � -- ---� - --'-- -------- - -'- - --- - �- ------- _ .-- --'----'--- — .' ! - - -- - - - _-- - -- - - - -------- --- - -_ - - - - ;-� -- -- - � '-a�?0 c.n^ v'2� �� z.2 Cid �{ 4N�i I �� ?'�'V �3�V Q'a acr-i�,QN`v�l Q S`1V i l -- - 5�7C„ t �-" r149 - +al-o9 dc�— � L�ti��"� - - �i, " C~'�� i - - - - - - -- — - �a=--s'� ---3�a��2d j,c�i�,�hs--�� --�p=�;i --------- — -- - - - - - 1 � •c�,-� � 9c-�.cs��--- yJ:.h ��-� �l -�N�-�rn� i-- ----- - -- a� �ve,-a�v �n - �,, r�oa�- o �Q� � a.r.i:L : ;� -- - L7�2b '� �� ;� - - �.�5' ��11 •� zL4 : C`�u..�-i� ; -- _ _ _ i - - -- � - - -- -- - - - -- - -- - �:,Q��'�y�1�-l� - �7c-„ t c�v� t�-- _ ��, , ----- � - - - .�,�� ; �-� :,o�: -.-- - � -- --- - ---- --- - -� - -- — - -- - - - - : - - - - c,bb � . L r.,�,,,y.� . �y,�; ; -- - _ �i I � . �� ,, � .. i . -- --- - �p�r -- -- - - - - ---- - — - i v' �~� o F C�,� M,�� . ------ --- ----- --- ---- - - — — — --� -- ------- �'�_ Tk� ---��--Q-�c.� __t��_ � _3-1Z- -�_ _ l(o`k`" �-� _ ------- - --- -C'`-�5r+'-v-�G��G,�__`�z�o�`1- -��_ __�,J__ 6.��A,.sz� ----------I W_t4�-� ---i� =DR_A�,..�.rac�_1z�4�..�eR-r3r-t.�� -C��'---- ---- -- - - - - -S a�o- �o�Z�- ' -�Zo� -- P�A1. � P�e - � S _ - -- - - I - -l�$b2� u'� ta-�� _ 'j� _ _ Gr�e-^�PL._�" T� _ �'(zo�t3- � _ � _ P�-ss� �s z.e�'( �oe. . occuP�c.� . _ _ - - - - � -- - -- -- — - ----- -- - - -- I---- �(o,� � �- �., �,A�,> - --- , - - - --- — -- - -- - - — �� ..�s��Po� 0 � - - -- a - - - - .-- -- -- - - ----- -- -- 1--- ----- -- - -- -- - --- - - - ------ `Y,�.��. '? 19 9 v - - � - - --- ' - ----- ----------P�•---- ------ — � --------_—_---� -- ------_--- -- ---- --- -- �. -- ---- -------------- - - - -- - -' - I - ----- --- -- - -- - - - - - - -- - -- -- -- - — -- - - --- - -- - - - - - - - -- -- --- -- --- -- - - - --- - - -- - - - - - - - - - -- ------ --------- - -- - , -- - -- ---- - -- � -- --- -- -------- ------- -- - ----- - - - -- � � - -- -f� --- - ------- ------- --- , ----- - -- - - - - - - - --------Irt-- ---- ------- ---------- ----- - - - - - -- -- �-- --- -- ------ - - I- --- ---- -- - - — - - 1 -- - }-- --------- - -_. --- . ---- _ ---- -- - - - CBRTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCBOOL DISTRICT il- ,:,3�- :;- Developer/Applicant: ��h �cw�O l 'DD�' ��-'�• Address: ��95"1 r�l(Lel.{ -si2a�j /J�.-�Pv�T ,P�L-!. CA.. �12Co�� J Telephone Number: ��}�4�'144-i�,r� Trnct/Parcel and Lot Number(s): Loce�ion of Project: 2�-IZ �. �I �� T• l"vm'n Mr�n.�m•�r>i>-� Number of Square Feet of 5'��` __J:j.j90 ,c/ �r Residential Space _iv:;S+ x $1.50 TotaT ��%' Number of Square Feet of " Commercial and Industrial Space x $0.25 Total Commercial/Industrial Project is: (Check One) Mini-storage Motel Movie Theater Bank Racquet/Health Neighborhood Shops Warehouses R 8 D Heavy Industrial Hotel Regional Shops Medical Office _ Light Industrial _ Office Park _ Preschool Au[o Repair Haspitel Large Office Office Bldg. Restaurant Fast Food The provisions of Covernment Code Section 53080 are no[ applicable. This cer[ifies that the above-named Developer/Applicanc has paid school facility fees in compliance vith Government Code Sections 53080 and 65995. Checks are eo be made payable to Nevp t-Mesa Unifie School District. �� Busi ss Menager Nevport-Mesa Unified School Discricc The above representation as to square footage is true. Developer/ Applicnnt agrees thaL if it is later determined that such represen[a- tians ore not true then this cer[ificate ehall autometically terminate and che appropriate City/County shall be notified. Date: �� 1' t�` \ � � V Devel er/App ican[ �' �'A�o u..1�2R- PR-oTc-3'C', � MP�Y 1 �S�d �� f ��- Tt�.e CeIP�!ano GOURMET FOODS AND SPIRITS 250 OGLE STREET, COS7A MESA. CALIF. 92627 (714) 650-8463 Nr��z�,� a. HPr�s�� VV �4nn�� ,�� `-� Cov�.Cy-�rrv , �� ¢� ��8� ��-e,�_ � � �� , ,Q,�n.� O�n�-�-�v.� - i rn�� ,�-, �� l'1,��-� �a-��-( �;�vr��y/ �— � L �.tiL�ti��. o,-,� ��1,�- � �:�:�- , P� � � � �� CATERING FOR ALL OCCASIONS l, /� �i,- . .' S � l� �tr �� \ -TTY OF CUSTA MES _ CALIFORNIA 92628�1200 P. O. BOX 1200 Insulation Certif cate 3"1 Z-E• I(o`µ` �T' G�sr� a-t -- - rr�,� �a sa�« c�ry �-i.3(��. Counry Subdivision Lot Number ROOF Material Thiclrness (inches) EXTERIOR WALL Description of Installation Brand Narne Themial Resivance (R-Value) Material �—�crS�3 "� ��6oc�j B�ndName Thiclrness (inches) �" '3 � � z _ Thermal Resistance (R•Value) �L — � � CEILING Batt or Blanket Type � J (3�-ta,ultctT Brand Name q�.J L� �-ti �� R-u �_�_ 'Ihiclrness (inches) (p � � " 'Ihertnal Resistance (R-Value) (Z —1� Loose Fill Type vJ O Brand Narne Contractor's minimum installed weight/ft� Minimum thiclrnest inches Manufact�er's insialled weight per syuare foot to xheive Thamal Resistance (R-Value) RAIS$D F1.00R Ma[crial �`fSj1s'C�-�tec sz P�-K BrandName Thiclrness (inches) '[hertnal Resistance (R-Value) SLAB FLOOR Material Brand Name Thiclrness (inches) 3 /Z�� 'Ihecmal Resistance (R-Value) �'idth (inches) FOUNDATION WALL Material G�1� � Brand Name Thictrness (inches) "Ihermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above [ocatio� in conformance with the current Building Energy Efficiency Standards for new residenual buildings cootained in Tide 24 of the Califomia Administrative Code. � SignaturenndTille �' 1 S�Co �5 �1 Licrnse Nwnber '.�3�%`1 � `t.b Dem Licrnse Number �— Da�e Pfl0.1ECT �{OOflESS: �;j 7?, E 16 TH S T �` OWNFfl'S N�ME: HANSON ♦: aooeess: SA{�fE uxiT: �' 631--4079 iRBCNIENGINEEfl: ' ' BEG.NO.: � aooeess: � uert: Y PENMITTEE: i]'IM JENNINGS CU.''iTbM MASON ( 714 ) 645—f3512 noosess: z7.36 NGWPOkT BL ' C.M.. CA 92627 LICENSED COHIMCTOB DECUMTION: I �ereEy aflirm ihat I am IicenseU unUer proNsions at CAaDter 9(commencinp wit� Section � 7000) oi Oivision 3 of tAe Business and Prafessions COAe, anA my license is in full lorce an0 ettect. cin uc.: 0 4 5 4 7 ST�TE UC.:O /)1 � cuSs1 C 2 9 oate: �/ Z 7� Sipnature: ��1�(n"� � Ig't'L'�t- �--- ,/ WONKFRS' COMPENSpTION OECLAM710N: I hereby aliirm ih I have a certif te of wnsent to selt-insura or a certiticate of Workers' POUCY N0. n Ly¢a�cg, q� y cRrtiLe� copy tAer¢of (SectiE%3800,TEab. C�3 / /� O � k'W VbltlS U cornr�xv: GOLDEN EAGI.E ❑ Certilie0 copy is here6y Iumishe0. ��etlife0 coOY �� etl �h I�e Buil inA Oivision. C Date: � z � I� pppliwnt EXEMVfION FlIOM WOBNEPS' fAMPEN511TI0X DECUMTION: (Thi section neetl not be D�e�etl if ihe permit is for one 100) or less�. I certiry tAat in the Dehormance of the work br wnich tnis permit is issued, I shall not employ any persan in any manner so as to Decome subject to t�e Workers' Compensation Laws of Califorttia. • Date: SiAnature:� NOTICE: If, atter maltinp I�is declarztion, you shoutd�6ecome sublect to the Workers' ComDensatron Orovisions of ihe Labor CoGa, you must fanMvith compty with suc� O�o�sions or this�permit sAall �e Oeemetl revaketl. CONSTflUCTION LENOING AGENCY: Pherehy aflirm thaM1there is a consimction Ien4inA apency forthe petlormance oi the workior whi[� this permii i5 i55ueC �Set�ion 3097, GV. C). • LENOER: . � � RODflES3: � . , OWNEB BUILOEP OECIAMTION: I herehy aliirm ihat I am exempt from tAe Cantractors' State License Law for Ihe tollowinp reason (Section 7031.5 Business anU Professional CoOe: � My city ot counry whicA requires a permit to constmct, alter, impmve, Oemolish, or repair any stmcture, pnor ro its issuance, also'requias the aDO�icant tar such Dermit to file a signed statement ihat hUs�e is licensetl pursuant to ihe Orovisions of tAe Contracrors' State License Law (CAapter 9(commencing witA Section 7000) ot Division 3 oi the Business anA Pmiessions Coae) or that Ae/she is exemD� �herefmm antl ihe Oazis for Ihe alle0e0 exemption. My violation oi Section 7031.5 by any applicant tor a permit su0ject5 the applicant ro a ciWl penalry oi not more ihan Me hundred Aollars (5500). � I, as owner of the pmperry or my employees witA wages as Neir sole compensation, will tlo [he work, anA t�e ❑ structure is not intenCeC or ottered tor sale (Section 70A4, Busineu anA Pmfessianal Code: TAe Coniractars' Slate License Law does not aDPly lo an owner oi a proDenY w�o Guiltls or improves t�ereon, anE wAo Aoes sucA xrork �imselVherseli or ihrough . his ar Aer awn emDloyees, Dmvitletl Ihat suc� improvements are not intenaed or oliered for sale. Ii, �owever ihe buil0iug or imDmvement is so10 within one year oi completion, the owner will have the burAen of provinA ��she UiA not builU or improve , lar Ihe Putpose oi sale�. � I, as owner ot �he pmpem/. am exclusively conVac�ing wi�h licensetl contrac�ars to consimct Ihe pmject (Section 7094, Business ❑ ana Profewions CoCe: The Contactors' State License Law tloes not apDly to an owner of OmDerty who bmlOs or impmrcs thereon anG who cantracts lar suc� pralect5 with a conVac�m(s�license Dursuan� to the ConVac�o�s' $Ia[e LiCenSe LaW). I am aware Ihat pmoi ai t�eir Worker'S Compen5ati0n in5urance 5�ou10 be pmvided Io me. , � I am exempt untler Sectlon: B. 8 P. C. for tnis reason: ' � Date: Owner. I Oo herehy certity Ihat I am aware ai and unAerstanA ihe requiremenis of California Health and Safery Cotle Sections 25505, 25533, and 25534 anG t�at i or any tuWre OuilAinp occupant wilVwill not (circle one) neeA to comply wit� saiA state coAes antl Ihe repuirements /or a permit for cansimction or m00ifiWtion from t�e Nr �ualiry Manapement Ustrict. Residentlal tonsimpion appliwtians are exempi fram Ihese D�ovi5ian5. oate: Apolicant Illere�y certityt�at I have reatli�is application antl state orGinances anA state Wws relatinA to huilainq con5irucfion � pmpeM �ar ins ction purposes. oate: jZ d Sipnatur� Onver's License or Social Secunry x: aEove inforq(af on is correct. I agree to compy with all city anA 1601d6 W�ite—BuilCin¢ Green—Cotle EnlorcemenY. Canarv—Aoolicant Pink—Revenue: GOIEenrotl—Assassor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: Q 095716 PERMIT NO: H 045716 PLAN CHECK NO: 02305-90 S GOVT: N SUFP: N CONSTRUCTION TYPF.: PERMTT TYPE: .''i'fR pURPOSE:'NEW JOB DESCRIPTION ; 179. LF CITY STANDARD ,6FT HIGH ALOCK WAL SQ FT: 131 CLAIM VALUE: 2;300.00 CALC—VALUE: 2,620.00 GROUP OCC: M-1 / COMMENTS: **�r*�t*��t�* **�ae*�r* �e�t�c x��e �t�t��t�x��r�r�r**x�*�t**+r�t�t**�-�r*�rx-**�*��t�t�t�r*�tit**�r**+t*it*�t+r�r�r*+tx-�r� K�*� Z O N I N G R E Q U I R E M E N T.ri S E T B A C K S ------:----- MAIN BUILDING -------- --�------- ACCESSORY BUILDING ---------- FRNT: F'1' IN REAR: FT IN Fi2NT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN . LEFT: FT IN RGHT: FT IN PAAKING REQr PROC�: PARCEL: 42519110 ZNE: R1 REF NO: PLANNI,NG NQTES> FOR THE ERECTION OE' A 6FR HSGA, 131—FT LONG BLOCK WALL, ONLY� � 3E iF iF �1E �E iE iE iE iE 1E iE iF K- 3E if �1f iE iF 3f iE iE if if It 3t if 3F ik IE 1f iE jf 3E iE iE iE ff �E iE IE 1E �E iE k k jF iE iE if iE iE 9E �F �f !E iE it if �1E iE iE 1E �E iE iE iE iE 1E iEiE'it if iE it 3E iE if �('iE � D E V E L 6 P M E N T, S E R V I C E S R E Q U I R E M E N T,�S ZONING APPRUVED BY ____�, �� DATE: i= I? -�O ' BUILDING APPROVED BY : UATEi _�, APPLICATION ISSUED BY: � • DATEd �/ —`'o � �EiEiF1FfE1E1E1f�7E1f9E3Eif�lFfElE3EIEififlEik�TF�{F TF��3FikfEiEiFif1E1k1EiE1E E �)tif 3E iF M 1E if !E �k if if �f iF iE iE If ik iE 1E 3f 3E 3E 1E if iE 3F fE if �E iF it M iF iE it i! i6 #�E iE IE iE 3F iF iE iF 1E iF iF ik ik ik k iF iF ik iE 1E ik if ik if iF if iE iE iE±E iE if �E if k iE iE k�E iE it 9E 1E LEGALIZATION:N F E E S—U M M A R Y STRUCTURAL SEGMENT:Y BLDG.PMT PLUMHING ELECTR.LC ;MECHANIC FTRE SMIP/RES GRADING PERMIT 54.00 ' , ,50 • SMIP/NON—RES PLAN 35.1U • ' i�' ISSUE FEE �• � 6UILDING-DIV—> PERMIT '•ISSUE PLAN—GHECK TOTAL- PAID � DUE TOTALS----> �59.50 0.00 ; :35�10 89,60 f39.60 .00 r ' REVENUS.DIVISION T'OTALS=-> " COLliECTEDi d9.60 UVER/SHORT: • 00 BLDG PMT PLUMAING ELECTRIC MECHANIC FTRE SMIP/TOT GRADING PLAN--CHECK 54.00 , .50 35.10 [� �E iE �t IE �F 3E �E 3E if !E 1FlE iE iE iF 1f 3f !E 1F iE #!E 1F 3k iF ff fE k fE iE �E k IE iflF 1F �E iE iElf �f iF if ik fk iElE i! If ff �IPlF 1E iF iE 1E ik ff 1E iE �! fk iF f! iE ik iElE iE it jf if iE ik �lE jE �f iE if 2 N D I V I D U A L F;E E H R E Ar K,D O W N 'fYYE QTY D E S C R I P T I O%N UNIT COST TOTAL COST SFR 131 RES—CONCRETE HLOCK'WALL �" / FT. 20_00 2,620.00 END OF` FEE5 i ; 0 0 . 1 b u 01 o00Px7732-000`1734 T�7 T $9.6G DATEn 01/11/90 7I17E: j?2:76 CONS'FFiiCTiON AND PLANNING POO, ;PA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date inspector 7. Temporary Electrical Service or Pol_e;; � � 52. Pool & Equipment Location _2..�Soil P,ipe-Undrgrnd.. ' � � - . 53. Steel Reinforcement . � -• . -- -. �3:�Electrical Cond"uk�fJiility-Undrgrnd:� 54. Forms � ��4. Electrlcal Conduit--Undrgrnd. .��: 55. Electrical Bonding � 5. Steel.Reinforcement -� x . 56. Pough Plumbing & Pressure Test � ° 6. Electrical UFE�R;Grnd. � 57. APPROVAL TO COVER-GUNITE � 7. Footings ��r J�(, p0 �� 58. Electrical Conduit�Undrgrnd. � -' 8. Foundation ._.. _ � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Und�grnd. . • 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ; - 61. APPROVAL TO DECK 11. Property Sewer.�ine & House Conn_ection ;__ 62. Backwash & Receptor-Final � 12. Sewer Cap _ :� �� 63. Heater & Vent�Final � 13. Roof Drains � '� � ' � , �; _ 64. Plumbing SYstem - Final 14. Rough Plumbing � - 65. Electrical-Final 15. Rough Electrical�Conduit � � 66. Solar SYstem-Final 16. Rough Electric Wiring ' � 67. Fencing & Access Approval � 77. Rough Wiring Sign �:' 68. APPROVED�FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning _ _ _ _ FIRE DEPT. REQUIREMENT 20 =Rough F.actory F.ireplace :-:; ' - _ ' ^ ;. ` �APPROVAIS ;� _', Permit # � � - 21 'Ducts, in Str�ucture^ � •• •• - � ` - � • +�' =7p, Ondergroand Hydro � - � . 22 Ducts, Ventilating'` -. v; - .�� ,=W >'. '; 7�, producf:Piping O�Gas ❑.Oil 23. •GasPipe-Rough & Test -� _ _ � t �, 72, Underground Flysh'�' - - 24" Roof F�aming ;' r`" - - �+, :�. 73: Undergm`d. Storage•TankyO Gas ❑ Oil 25. Roof Sheathing i� •� • �* �_ . �_ � 7q--Overhead Hydro-',_� * 26 � T�Bpr Ceiling (Structural) &-Monocoat';� ' ~ � {� 75_- Dry Chemical _ - Y � ^� �� 27�-Frameand Elashing - _ � - - + 76. Dry Stand�pipe �`� � _ ,_. "28. Lathing & Siding ,. '� ' _ ��,.= �; �� ". "' 77:- FIXED SYSTEM'FINAL� _. •- 29. Insulation J r' _ -' � , ��. �� 7$; FIRE PREV. FINAL ' �' � �� 30. Drywall Nailing � _ - :. �;: ;. :HEALTH�DEPT, REQUIREMENT _�31. Plaster Brown Coaf. _" �- -�• � f.� i, !'79.� FINAL INSPECTION x '� , �. �„32 _Electrical Power Meter,F.inal - K ^ , �,: �"�80�FOOD CERTIF�CATE ISSUED_ 4; ._ ' • _ •. rr. +� � : , �:33�Final Electric ��: - _ - M � ' .i. T � - � Notes:G✓.�/�� !/ ^. = 4�' Y' � l 34: Final Heatirig & AiF Conditionin"g- � � !' ! : 4" * , r " _ ..:,��y :T „ / 35 Final G`as Pipe-Test :�,.�-- - � - ,� . ''- x' �� Z3 ,O �''�0��" � g_��J� =36, Hood or�Canopy ^ ` ",� � " ` � � I* * �= -- ��; � -' - c. a <^;-, ,r.-c r� . , c,> �r: : -!37:.Final Factory Fireplac� ��- � � . '.:, 'x �� .. - � = 38�Firial Plumbing _ ' ` • � " ` - - ` � x s. s � 39`Water Se'rvice�Final, -- � � :T� � � � �� =- � r.�' �� - � �'� . ^40: Gas Service-Final � " ��t-^, ' " '� � " ' r �, �, t., � a = . - � �. <r, {;41.'Solar pomesiio-Pinal' `_: �� ' ' �' ' -`= '� �r. 'r i: � . _ . %: .. 42. Backflow Preventer� K ` � � �� " -" ' `i ._ ' n., - .i .T, A'?" � ` 43. Backflow Iriigation ' � �� ,� F ; ,- , � J ` C': � • : '.44. LandscapelrrigationSystem-�' '^-`� �� ^ =� = '7`'`: ;� - -=:� }` , ;, . - r ��n '-' rT- n e: .. X� S- . �� • _ - - f�^'_. K �. r- ^ ;-� � �' � _.. " - _ " 45_,Sound .Attenuation . .. 5; . -; ,;, k y. , :,p • , _ " 46:•Handicap Regulations � � t� ` , "' �; �= _ - _ �� I � LY . . [' "� ^J [, _j' _47�=� FIN'AL STRUCTU�fiE & BUI'LDING _ ';. � g�r% . ' "' ; � '' J48:FINALPLANNING F�� ^� � � � "x^:!�� ^ . � _. w i - ;i - . = 49.�Electric�Release tdEdison ' = ' ' � ` + ' , ' " . . .t- � � . : . � n . c� i - 50: Gai Release to Southern Califomia Ga5 Co * � '�� = -'" ' � ' R cT A' J� �i• •J _ J51. CERTIFICATEOF'OCCUPANCY ` " ^ ` ` `' '' � • No. Date ,; 1, ,, ��pRp�� A esa Building �ePt. � �� Costo ►`� \ �\'L�e�—`�� , i C�jY /'�R� DpTc� Mi.•,�. �' � � 8 AT All TIMES E: r � BTHESE P�lGcc � ITr+�O F�7�"�� ,FI ��' - '• � , g APP0.0 � NOCHA• .�?P'r" '�PPERNJl TRUEDIO�" .. ^�. TF'.E'1" 4P%Cc Onr6T �� SHpLL A�;,e"`O� t O�ING ` G ' r t,`�'OU:;`.�';'. FFC�`E�OK`t�;'��tqRp45WO0.w0��.� : PIAN- pEFNFFO;'I��ON°,: :.'.xi.�;;S.�FadaSS1� . ¢iSy '.J � . V. E7.C''�� :llt. COO"=SHh��°�._,;t. Ei t5 t..v F� �PON P��GSc1U.' � WHICH tt A. � 1 �. � ;� �?.`�qp��:QPS �.; C9oN U� k� N.�a SH= 13S .. ai ta -'��v.@E qk= � �;y: :. . ;'...:� _�*�E �� JF FfiOM j�E��tn=� C.4"sCIFiC�' : .@G " _n_..� ... N tHEFEUt �„CE G� f pRCN� Z:,Ea �'' ,;�.;� :t -...�.C. i:.dt: ��D �OtMER ORvINA f UIID�NG t G2 UF 1.N Fl Y '.Nk.�'�;'iNr15 C-..J IN`ltOLA• I ,� TH� OT/. �-+'�`. !T b' N[!ID[NC[ � W � � N � ; APPROVED � CITY Of COSTA MESA j � PLANNING DEPT. iUUECT TO Npp, pg�, � 1 ar �'� n� r�� o I ou�oe o. w�w„a. j 1 28' II[!ID[NC[ � � b-�- 13 f ' (,�. � 1�� , "`'Q� . -�-� ��"P`_ 1-a,,.a''' `l� � . � / /� b� STNEET II[61DEMC[ '�7Z C, � NUIOLMtL tl� F W W Q � N ;. Cement Coping Optional � Channel8bck With 1-3/S�i Horizontal Top of all Fences For Pences 5' or Lea Vert. Ban 3/B" � at 4' -0" O.C. For Fences Higher Than 5' Vert.Ban 3/B"� at 32" O.C. � Fill Celb Solid With Grout Where Steel Otturs Reinforcing Steel Shall Conform to Sec.A-75-39 A.S.T.M. All Steel to 6e LapPed 24" Or t0 Code NATURALGRAOE TW0�3/B"$ OARS � CONTINUOUSTOP & BOTYOM � - ilOQ1iSTEEI MUST BE TIED IN P.LACE AT TIME OF TRENCH INSPECTION. TYPICAL 6" CONCRETE BLOCK FENCE a x LL � > w s = a >Z a i 'o W O u H �r. ' e � oe D F�— W I DT H o SEE CHa � OELOW D' I '�. FOOTING REQUIREMENTS CHART GENERAL- NOTES MORTAR; One Part Plastic Cement, and GROUT; Three Ports Sand One Part Cement TAree and One Halt Ports �cnd COPING: One Pmt Cement, Three Parfs Sand C�NCRETE: Well Mized 1:2-I/2:3-I/2 Ma:. of 7- I/2 Gnitons of Watflr Per Sack of Cement GROUT MAV BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCUHS. CELIS AND AREAS Of HOHl20NTAl REIN- FORCEMENT SHALL BE CLEAR, CLEAN & FREE OF ALL MORTAfl DEBRIS, ETC. H OF E4RTHTCOTH i/3 THE HEiGTH OF FENCE BELOW ��OTTOM OF FOOTING. SCALE: I/2�� = I' WIOTH . . . . . . . . . . . . . . .14�� . . . . . . . . . . .14�: `... . -. . I._12_'__-.: ,- . . r . . . 12��, c ......� 7HICKNESS . . . . . . . . . . . .10��. . . . . . . . . . . .10" . . . . . : . .`.. . . 6�'. . . . . . .�. . . . 8�� ' DEPTH OF EARTHTOOTH . . . 24" . . . . . 20'� . . . . . . 16��. . . . . . 12° SPACING OF EQRTHTOOTH. . 12' . . . . . . . . . . .14� . . . . . . . 16'. . . . . '. . . . . 16� City of Costa Mesa California OWNEiiS NAME �y s o_ ___� JOB ADDRES . .� Z — 1 ` =� 1 PERMIT NU BER:_ _� � _ � \ � _ � Bui�ding Department SIGNATURE _ � �::.. �,..: , _... _. _,: ze��s� ��. ez r`: � , :. �: .. . ..., . �A f�Y �fL�. A�REE2'IErIJ' ZFIiS AQtEEMENT, made and entered intn this (�� day of � 9U ��/, �/� �_ , 19$�', by ani berireen �jfl LIC 1Hl�i(( hereinafter refetted tA as "LAND oh3�7ER", and �J��,'� �IiIT/% hereinafter refen�ed to as "AG7ACFS]T PROPEKISC CWNER". It is hereby agreed that a party 4ra11 will be constructed on the prcperty line�etween 3�0� �. /�fT �jCT% �j:� � �%p�j �-. / � r /1 / (Address of Adioinirx� Praaerties) in the City of Ccsta Mesa, Coimty of Orange, State of California, as per �p recotded in Book , Page_ of Miscellaneous Maps, in the office of the CoLmty'Recorc�r of said County. The party wall shall be Fermitted to encroad� �. \ IN WIZNESS �EOF, the parties ha,e entered into this Agreer�nt the day arrl year� first above written. � ' La*7D Cdnica � �� ( Signat�e ) U1uL��- �� V� So,� Name (2yped or Printed) � - �'a � �"'" S+ ; �� . ,_ (Ad3ress) C� `�� ; �"�.b�� (Address) ' ��Ss�� yl ' � � � ' � W �- � ; ..:�. �y�ali � � Z � ��ti' -� �' 1 ��P �-r`'l f t o � de oz._no. t) OWNER WTLGROj9E G(lNS'iR COI�IPANY TivC DATE 9-I�-KH _ JOB ADDRESS ��o,�+ k�y,��a� B[IILDING PHRMIT NO'. �33Q AP. No. LOT �'- "�UP I Ih�PECTIONS and brown F ��inq Fixtu� b. . Gas Test 'rYPE V ZONE DATE WORK PLAN SUBCONTRACTOR I . DATE xa r: ISSUED NUMBER MILLER, C.E. DATE 5-26-59 JOB ADDRESS 372 16th Place BUILDING PERMIT N0. 9L�0 GF.NF,RAL CONTRACTf1R Mai'9}lall VALUE S 900_iJi) AP. No. LOT P 'ECTIONS Gas Form DATE I�'IRE SUBCONTRAGTOR ZONE R OWNER DATE 12 ]OB ADDRESS 2 E, lbth St. BUILDING PERMIT NO. 8290 GENGRAGCONTRACTOR Owner-Builder VAL[IRS 09�� . f` �uP INSPECTIONS � F �iny Fix[u L.. . Gas Test V FIRE ZONE DATE � gUBCONTRACTOR PLAN NO. PERMITSISSUED DATE NUMBER - ,.. : _ �2sv . COSTA MESA BUILDING DEPARTMENT P.O. eOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN a� AD COSTA MESA. CALIFORNIA OWNER � � MAIL AOORE/5�5 QTY ` ARCHITECT OR � 'NEER AODRESS CONTRAGTOR AD�RE55 � � I�� LEGAL LOT �/ oescaianorv No. b A.P.NO. � I /� � I OF LOT 63 �X /�v' USE OF I.�OIISF E%ISTING BLDG. SETBnCrc IiNE FROM �" I CENTER OF STREEi 7.f. S. % TEL. � NO.�� LIC. N o. r� / CITV LIG �j �( NO. TEL �'� � NO. iLOCK / rvo.or e�ocs. �IOW ON LOT ,sa.� �',�,o�e TREAR YARO!\ SIOE YARD RIGHT,L, �� S/LEFT C(�j DESCRIPTION OF WORK NEW ALTERATION I ADDITION REPAIR I%��MOVING � � _ pEMOLISH BUIIDING�� / v2� ! NO OF ��/ SIZE n �j ROOMS y STORIES COVERIINGWALLPLA�S/I%FICOVERINGTR C� � IISE OF NEW /l � / � _ �= �� F��C�6M C�i� r�,�9•T8 V'�— F1�1A�CE DEPi. APPLIG�AT�O'O faFOR��PERMIT BUILDING FOR OFFICE USE ONLY P eY I/�T/ " E�/ �J �� T i` I5� � ��a - �=.'�6 �� COSTA MESA. CALIFORNIA r coR �0 2 DATE TIONS � ��. " -�-• _ �_ ��5� `� A'Q R P in s�. Y 3 e A,1 I '� � �, SA F'L.��ip;G DraT �Q�°�� TO (3LOG. DEPT. REG. I MEFEBY FCN!IOWLEDGE iMFT I MAVE flEAD 1M15 I�PPLIC�TION An'D purpose of $T�TE TH4T THE M1BOVE IS CORRECT AND AGPEE TO COMPLY WITH ALl CITY ORDINANCES PNO STATE LM1WS REGULFTING BUILOING CONSTRVC- iioe+. ��'% A �/ / • ;/VL"_"LLN VALUATION i� // SIGNATURE OF S%la/�1�. PERMITTEE � ..._..__'___ ._`.'_ 'r'J i O� PERM�T FEE S � PLAN CHECK S TOTAL FEE 5 U yQ I VDM! OWNER HANS6N CHARLFS DATE p_19-59 _ JOB ADDRESS �7g East 1�t37 ��2'8Bt BUILDING PERMIT NO. SG79 GENERAitCONTRACTOR /kmar_RnilAor VALUE $ -i$0.00 'IRE ZONE DESCRIPTION OF WORK ; I�...PECTIONS I DATE I SUBCONTRACTOR I DATE PERMITSNUMBER coat. Test !� �3i�� a'�J . . COSTA MESA BUILDING DEPARTMENT P.O. BOX 3�� COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN BUILDING ADDRE55 OWNER � MAIL .. ADDRE55• i CITY �� ARCHITECT OR F- 'INEER ADDktiS A COSTA MESA. CALIFORNIA 4CES �L��LSnn/ „ ,- ��Y�S. �'7 LEGAL ILOT OESCRIPTION 1Np, A.P.NO. /�`,� � S�ZE / .3 � OF LOT p USE OF EXISTING BLDG. SETBNCK LINE FROM CENTER OF STREET TEL. s/� NO. ��.I LIC. NO. CITY LIC. 2uit d[ri1 No. TEL. t NO BLOCK 'fR7�C —/� NO.OF BLOGS. SIDEYARD RIGHTF1(/s, LEFT �Iif(�/s DESCRIPTION OF WORK NEW ALTERATiON � I ADOiTiON REPAIR MOVING DEMOLISH BUILDING i 1 � NO.OF SIZE �O Xe�� ROOMS � STORIES EXTERIOR WALL /J/ _ y'_ _ ROOF �� / ,� � �� .d�iL�v �13J5%4'= FIfVAI��E t�EPT. f 1iY �� R�Tr n1'FC� APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. PEFMIT NO 6UICDIN � ( � / ADDRESS � Z [� � ��p �' COSTA MESA. CALIFORNIA FIRE << p DATE C C IONS ��i. (1 �� ' I �� ri : hi' �l - . n�.. nr . G (: i.'?�. SUBJtC( 7 �LDG. GCFT. � s� pLAIV 7..CH. �yij� $TwTE THnT TNE ABOVE IS CORRECT nND nGREE TO COMPLV WITX iLL CITV OHOINANCES AND STATE LSWS pEGULnTING 9UIlOING CONSTRUG TiOrv. //n VA�UATION SIGNATURE OF ��n //� � �J��a_� PERMITTEE A G�1 � y/�J/ ryy $ Y V PERMiT FEE S � PLAN CHECtt S � TOTAL FEE S c_ � Mf OWNER - HANSON� CHAF%LESV. � DATE 1�=9-59 JOB ADDRESS 372 E, lbbh Sb. BUILDING PERMIT NO. S9%O GENERAL ONTRACTOR p�.��r - Builder VALUE $��00� . No. LOT TRACT FIRE ZONE DFSCRIPTION OF WORK Brick & redwood fence ('�'�llP TYPE � ZONE PLAN NO. 8970 . �......._.��_�� IhoPECT10N5 DATE SUBCONTRACTOR 1 . DATE I NUMBEH coat OCCL[PANCY •��.2�C,� I�t-o /'�ALlvt„r� /i �_ l� S- IvU I/�"'L� I_ Form 2l0—oM-1-57 8970 r ,. , P � � COSTA ME5A BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. GALIFORNIA FOR APPL/CANT TO f/LC /N COMPLETELY TYPE OR PRINT BUIIDING ,y, C AOORE55 `J COSTA MESA, CALIFORNI:4 MAIL '� T A�DRE55 / CITY�-y /}� TEL. Lin _ p�$/fj /•/��"/t'� NO. %7�� ARC"�TEGT LIC. OP '�INEER /��ia./` NO. LEGnL I LOT SI� I DESCRIPTION NO. BLOCK A.P. NO. �,Z - e7J/- I� SIZE %/�1 �/ �� 1 2T�� I NO.OF ■ SET6NCK LINE FPOM ._ � I LEFT CX/ 57 I RIGHT E DESCRIPTION OF WORK REPAIR I IIMOVING I IIDEMOLISH BUILDING / NO OF L/ 1 SIZE �O X�� ROOMS ] STORIES ` EXTERIOR WALL�j ^7I ROOF � COVERING Q-S/�I�OVERING i1/ � RoC. ,� ,� � ��, -�--_-� I HEFEBY ACKNOWLEOQE THAT 1 HAVE REAO THIB APPLICATION AN� 9TqTE THAT THE ABOVE IS CORRECT ANO AGREE TO COM- PLY WITH ALL CITY OFOINqNCE9 /NO STATE MWS REGULATING BUILUING CONSTRI/IC�TION. y� /� SIGNATUREOF /`D_.O_ /� �/1/A�,. _iti , AUTHORIZEO AGENT (�� C��n�� fIN�y ` � A C D�Pf.- r.�TY pF r,qSTa MESa APPLICATION FOR PERMIT BUILDING fa,e afficE usF oNcy I NECEIPT NO. I P68MLT ...) �f%t L—' / C� � �e COSTA MESA. CALIFORNIA ype - group ZONING " ZONE � I NO. OF I USE OF NEW / �/ PLAN9 OUILDING APPROVED /� DATE �/ BV L uu ��` � 3 �` THE AMOUNT 6HOWN UNOER VALUATION IS FOR THE PURPOSE OF ESfABLIbHING A PENMIT FEE ONLY. - VALUATION PERMIT FEE $ � $ I' / , /\ PLAN CHECK $ l..f Y � / TOTAL FEE $ 2—